Forceps are _not_ recommended for the after-coming head unless the child is dead. If the child lives, the Smellie-Veit is more-successful; and if the child dies, the cranioclast, if possible, will save the mother much suffering and avoid some injury to the tissues. =Transverse or Shoulder Presentations.=—These are cases in which the long axis of the child lies directly across or obliquely across the long axis of the uterus. The shoulder (scapula) is the bony landmark, and the part which most frequently impends over the inlet. This presentation probably occurs once in two hundred labors. It is due to the same conditions that were given for breech cases; namely, weak abdominal or uterine muscles, pelvic contraction, placenta previa, hydramnios, and twins. It is easily recognized in pregnancy, and must not be neglected, for it is impossible of delivery without first changing it into a longitudinal presentation. If this correction is not done, rupture of the uterus is liable to occur, with the consequent death of both mother and child. The _treatment_ is invariably version. =Face and Brow Presentations.=—The face presents once in about three hundred labors. In this case, the head is completely extended so that the occiput rests against the back of the neck. The trunk and spine are straightened out while the legs and arms remain in the normal attitude of flexion. The causes of these anomalies must be sought in those conditions which bring about the deflexion of the chin. The most common are pelvic contraction, large child, placenta previa, hydramnios, goiter, anencephalus and multiparity. [Illustration: Fig. 68.—Face presentation. (Bumm.)] Face positions take their names from the location of the chin (mentum—Latin). Thus the most frequent face position is the right-mento-posterior. The diagnosis is not easy and may not be conclusive until the bony prominences of the face, such as the nose and orbital ridges can be distinguished by vaginal examination. [Illustration: Fig. 69.—Descent of the chin in face presentation. (Bumm.)] The delivery is protracted from three to five hours beyond the average by this complication, and the mortality is higher both for mother and child. The face is badly swollen and disfigured, but the normal condition of the tissues will be restored by the end of a week. Most face cases terminate spontaneously, but operative interference is not infrequent on account of danger to mother or child. Version or manual correction of the presentation may be done before engagement. Forceps is the operation of choice after the head is fixed in the pelvis, but it may be necessary to precede the delivery by a preparatory pubiotomy, or in case of failure, to do a craniotomy on the dead child. If the chin does not rotate forward under the symphysis, the labor is impossible without pubiotomy or the destruction of the child. In general, the case should be left to nature unless some definite indication to interfere develops.